Provider Demographics
NPI:1518947548
Name:SCOTT, RANDALL EUGENE (PA-C)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:EUGENE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 PITCHER PLANT CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-9470
Mailing Address - Country:US
Mailing Address - Phone:850-554-4608
Mailing Address - Fax:
Practice Address - Street 1:3354 PITCHER PLANT CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-9470
Practice Address - Country:US
Practice Address - Phone:850-492-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-365363AM0700X
FL9103913363AM0700X
NC102483363AM0700X
MDC0002449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant